ISSN: 2572-4193

Basturk et al. J Otolaryngol Rhinol 2019, 5:054

DOI: 10.23937/2572-4193.1510054

Journal of
Volume 5 | Issue 1
Open Access

Otolaryngology and Rhinology

Case Report

An Iatrogenic Foreign Body in the Maxillary Sinus: Report of an

Unusual Case
Fatima Betul Basturk, PhD1*, Dilek Turkaydin, PhD1, Sertac Aktop, PhD2 and Hesna Sazak Ovecoglu,
PhD1
Department of Endodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
1
Check for
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Marmara University, Istanbul, Turkey
2 updates

*Corresponding author: Dr. Fatima Betul Basturk, Department of Endodontics, Faculty of Dentistry, Marmara University,
Basibuyuk Yolu 9/3 34854, Maltepe/Istanbul, Turkey, Tel: 0090-216-4211621

Abstract frequently associated with dental procedures involving

apical surgery of the maxillary molar teeth, these
Dental practitioners frequently encounter with instrument
procedures often create a pathway for foreign bodies
fracture during root canal treatment. However, these
fractures generally occur inside the root canals. It is not to enter the maxillary sinus [5]. Fortunately, displaced
usual that high speed rotary instruments snap and go further dental instruments in the maxillary sinus are rare [4].
to important anatomical landmarks. In our case report, a A literature search revealed reports of displaced teeth
high-speed Gates-Glidden drill perforated the root and [6], oral implants [5,7], gutta-percha points [8], dental
was introduced into the left maxillary sinus during a routine
burs [4,9], dental amalgam [10,11], impression material
root canal treatment. The dental and surgical management
of the case are described and the possibly more serious [12] as iatrogenic causes. There are also reports of a
sequelae are discussed. Practitioners must take great sewing needle which was inadvertently pushed into
care during dental treatment and endodontic treatment in the maxillary sinus by the patient while attempting to
particular, not to accidentally introduce foreign bodies into drain a dental abscess [13], and a wooden toothpick
maxillary antrum.
[14] which was introduced into the maxillary sinus after
Keywords an upper second molar extraction which caused an
Foreign body, Gates glidden, Maxillary sinus, MTA,
oroantral fistula. A gates-glidden drill in the maxillary
Perforation antrum has not been reported before.
In this case a Gates-Glidden drill which was
Introduction introduced into the left maxillary antrum during
Foreign bodies are occasionally found in the paranasal a routine endodontic treatment for an upper first
sinuses [1]. Causes include the escape of material molar was presented. The endodontic and surgical
through an oroantral fistula, from facial trauma, and management of the case are also described.
iatrogenic causes [2]. Most foreign bodies are pieces Case Description
of metal, wood or glass and they are detected by plain
radiography, xeroradiography, computed tomography, A 40-year-old female patient was referred to
magnetic resonance imaging and Ultrasonography Department of Endodontics after pulp exposure during
[3]. Rarely, they occur as a complication of a dental prosthodontic preparation of her upper left first
procedure [4]. However, practitioners must take great molar. The patient was immediately referred to the
care during dental treatment and endodontic treatment undergraduate clinic for root canal treatment.
in particular, not to accidentally introduce foreign bodies Enquiry into the patient’s medical history revealed
into maxillary antrum. Because antral perforation is she was healthy and currently not using any medication.
Citation: Basturk FB, Turkaydin D, Aktop S, Ovecoglu HS (2019) An Iatrogenic Foreign Body in the
Maxillary Sinus: Report of an Unusual Case. J Otolaryngol Rhinol 5:054. doi.org/10.23937/2572-
4193.1510054
Accepted: February 05, 2019: Published: February 07, 2019
Copyright: © 2019 Basturk FB, et al. This is an open-access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduc-
tion in any medium, provided the original author and source are credited.

Basturk et al. J Otolaryngol Rhinol 2019, 5:054 • Page 1 of 4 •

DOI: 10.23937/2572-4193.1510054 ISSN: 2572-4193

Figure 1: The panoramic radiograph clearly shows the extent of the Gates Glidden drill inside the left maxillary sinus.

Figure 2: Periapical radiographs show A) A broken Gates-Glidden drill inside the left maxillary sinus during a routine end-
odontic treatment for an upper first molar; B) The drill after root canal treatment; C) The trace of the removed distal root is
still visible 7-days post-operation; D) Asymptomatic tooth at the 2-year recall.

After taking an initial periapical radiograph, an access
cavity was formed and root canals were identified.
During the shaping of the root canals, the student
was suddenly aware that the Gates-Glidden drill she
used, to enlarge root canal orifices, had been broken.
A panoramic radiograph (OPTG) (Figure 1) and a
periapical radiograph (Figure 2A) were taken to ensure
the position and the extent of the broken drill.
The radiographs confirmed that a Gates-Glidden
drill was fractured. However, the broken piece was
located in maxillary sinus cavity. It was assumed that
the student perforated the floor of the pulp chamber
in between the distal and the palatal root canal access
cavities, mistook it for the entry of the distal canal and
enlarged the perforation site by using a high-speed
Gates-Glidden drill until the drill was broken. The drill
extended to the maxillary sinus with its rotational speed.
The patient was commenced on a course of amoxycillin
clavulanate and ibuprofen and was transferred to the
professors’ clinic.
The perforation site was covered by ProRoot MTA
(Dentsply, Maillefer, USA), the canals were obturated
and the tooth was restored (Figure 2B). However, it was
not possible to enter the distal canal as the perforation
site and the distal root canal entry were collided. The
patient was later transferred to the Department of
Oral and Maxillofacial Surgery for the removal of Gates
Glidden drill and hemisection of the distal root (Figure
2C).
The left maxillary sinus was entered through a
Caldwell-Luc approach (Figure 3A and Figure 3B). The
Gates Glidden tool was visualized and removed with the

Basturk et al. J Otolaryngol Rhinol 2019, 5:054 • Page 2 of 4 •

DOI: 10.23937/2572-4193.1510054
Figure 3: Surgical removal of the Gates Glidden drill A,B) Through a Caldwell-Luc approach; C) The Gates Glidden drill was
surrounded with purulent secretions; D) Removed with the help of a forceps; E) The maxillary sinus was irrigated and distal
root was removed; F) The mucoperiostal flap was sutured.
help of a forceps (Figure 3C and Figure 3D), the maxillary
sinus was irrigated with saline solution and antral
polyps were removed. Distal root was also removed.
Oral cavity was checked for an oroantral fistula during
surgery (Figure 3E). There was no interruption in the oral
mucosa which may suggest a fistula. The mucoperiostal
flap was closed with 4/0 silk suture (Doğsan, Turkey)
(Figure 3F).
The patient was given antibiotics and topical
decongestants for a week following surgery. At post-
operative review 7 days later the surgical site was
seen to be healing well and there was no evidence of
any oro-antral communication. Subsequent follow-up
appointments at 6-month, 1-year and 2-year (Figure
2D) revealed the patient to be both radiographically
and clinically asymptomatic. The patient’s physical
examination and radiological investigations were
normal.
Conclusions
The anatomical relationship of the maxillary sinus
and the roots of maxillary molars, premolars and
in some instances canines, can lead to numerous
Basturk et al. J Otolaryngol Rhinol 2019, 5:054
ISSN: 2572-4193
complications. The bone of the maxillary sinus floor
can be very thin and in some individuals the roots of
the posterior teeth project through this bone [8]. In this
case, a Gates-Glidden drill was accidentally introduced
into the maxillary sinus. There have been case reports
of displaced teeth [6], oral implants [5,7], gutta-percha
points [8], dental burs [4,9], dental amalgam [10,11],
impression material [12], a tooth pick [14] and a sewing
needle [13], all caused during or after dental treatments.
Foreign bodies in the paranasal sinuses should be
removed, even when they are asymptomatic in order
to prevent tissue reactions [1]. The exact mechanism of
how foreign bodies cause sinusitis remains unknown. It
has been suggested that foreign bodies may cause tissue
reactions, produce chronic irritation of the mucosa,
leading to a degree of ciliary insufficiency [1].
In addition, small foreign bodies may be transported
by the cilia of the epithelial lining in the maxillary sinus
in the mucus-containing fluid against the influence of
gravity, up the nasal wall of the sinus and out into the
nose via the ostium [8]. Small foreign bodies may be
silently inhaled causing a potential for the development
of pneumonia, bronchiectasis or lung abscess [8].
• Page 3 of 4 •
DOI: 10.23937/2572-4193.1510054
A case in which carcinoma of the maxillary sinus
developed in a patient with a metal foreign body in the
antrum for 48-years has been reported [15]. Also another
case which was misdiagnosed as an ethmoid tumor but
caused by a foreign body reaction to an amalgam filling
was reported [11]. Thus, it is generally accepted that
prompt surgical intervention to remove the foreign body
is desirable to prevent the possible sequelae of sinusitis,
mucosal cyst formation, foreign body granuloma and
persistent oro-antral communication [2,8].
The classic surgical technique for foreign body
removal from maxillary sinuses is the Caldwell-Luc
procedure, which involves opening the anterior wall
of the maxillary sinus [1]. Nasal and sinus endoscopic
surgery is another approach for the removal of a foreign
body from the maxillary sinus. If the foreign bodies
are large enough then their removal may not be easy
by routine Endoscopy [2]. In our case, Caldwell-Luc
procedure was applied for better visualization of the
antrum.
This case is interesting because, a Gates Glidden drill
in the maxillary sinus, is the first in the literature to our
knowledge; also, this is a dramatic example of how a
simple root canal treatment could turn into a surgical
procedure if the practitioner, a dental student in this
case, is lacking the knowledge of root canal morphology.
Foreign bodies in the maxillary sinus are rare issues.
They generally occur during or secondary to dental
procedures. Whatever the foreign body is, it must
be removed to prevent chronic infections even if it is
asymptomatic. Great care must be taken during dental
procedures and endodontic procedures in particular,
not to accidentally introduce foreign bodies into the
antrum.
Acknowledgments
The authors deny any conflicts of interest related to
this study.
References
1. Pagella F, Emanuelli E, Castelnuovo P (1999) Endoscopic
Basturk et al. J Otolaryngol Rhinol 2019, 5:054
ISSN: 2572-4193
extraction of a metal foreign body from the maxillary sinus.
Laryngoscope 109: 339-342.
2. Sharma R, Minhas R, Mohindroo N (2008) An unusual
foreign body in the paranasal sinuses. Indian J Otolaryngol
Head Neck Surg 60: 88-90.
3. Kaviani F, Rashid RJ, Shahmoradi Z, Gholamian M (2014)
Detection of foreign bodies by spiral computed tomography
and cone beam computed tomography in maxillofacial
regions. J Dent Res Dent Clin Dent Prospects 8: 166-171.
4. Smith JL, Emko P (2007) Management of a maxillary sinus
foreign body (dental bur). Ear Nose Throat J 86: 677-678.
5. Chiapasco M, Felisati G, Maccari A, Borloni R, Gatti F,
et al. (2009) The management of complications following
displacement of oral implants in the paranasal sinuses:
A multicenter clinical report and proposed treatment
protocols. Int J Oral Maxillofac Surg 38: 1273-1278.
6. Durmus E, Dolanmaz D, Kucukkolbsi H, Mutlu N (2004)
Accidental displacement of impacted maxillary and
mandibular third molars. Quintessence Int 35: 375-377.
7. Iida S, Tanaka N, Kogo M, Matsuya T (2000) Migration of a
dental implant into the maxillary sinus: A case report. Int J
Oral Maxillofac Surg 29: 358-359.
8. Liston P, Walters R (2002) Foreign bodies in the maillary
antrum: A case report. Aust Dent J 47: 344-346.
9. Abe K, Beppu K, Shinohara M, Oka M (1992) An iatrogenic
foreign body (dental bur) in the maxillary antrum: A report
of two cases. Br Dent J 173: 63-65.
10. Tingsgaard P, Larsen P (1997) Chronic unilateral maxillary
sinusitis caused by foreign bodies in the maxillary sinus.
Ugeskr Laeger 159: 4402-4404.
11. Macan D, Ćabov T, Kobler P, Bumber Ž (2014) Inflammatory
reaction to foreign body (amalgam) in the maxillary sinus
misdiagnosed as an ethmoid tumor. Dentomaxillofac Radiol
35: 303-306.
12. Dimitrakopoulos I, Papadaki M (2008) Foreign body in the
maxillary sinus: Report of an unusual case. Quintessence
Int 39: 698-701.
13. Fan VT, Korvi S (2002) Sewing needle in the maxillary
antrum. J Oral Maxillofac Surg 60: 334-336.
14. Şahin YF, Muderris T, Bercin S, Sevil E, Kırıs M (2012)
Chronic maxillary sinusitis associated with an unusual
foreign body: A case report. Case Rep Otolaryngol.
15. Birnmeyer G (1963) On late sequelae of metallic foreign
bodies in the region of paranasal sinuses. Z Laryngol
Rhinol Otol 42: 778-785.
• Page 4 of 4 •